Youth Membership Council Application

Applicant First Name

Applicant Last Name

Email

Phone

Birthday

Month

Day

Year

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone

Parent/Guardian Email

Multi-line address

Country/Region

Address

City

Zip / Postal code

Applicant Interests and Artistic Background

Describe your art background, classes you have taken in school and what you are most interested in doing as a member of the council.

Why do you want to join the HCAA Youth Membership Council?

I can commit to attend meetings each month starting in October 2025.

I am a current resident or attend school in Hamilton County

Show us your work

As part of the application process, enter the information for 3 pieces of your original artwork. Use “NA” in any blank fields.

Title of Piece #1

Medium/Materials Used

Size of piece

Title of Piece #2

Medium/Materials Used

Size of piece

Title of Piece #3

Medium/Materials Used

Size of piece

Upload one image each of work you are submitting. Files must be JPGs under 2MB in size each. Please name your files in the following format: Last Name_title.jpg

Medical Information and Care Instructions

If your child experiences a medical issue, what specific steps should the adult supervisor take to assist them?

Please list any allergies, medications, or medical conditions we should be aware of:

WAIVER AND RELEASE OF LIABILITY

1. Safety and Emergency Care

HCAA will take reasonable precautions to protect my minor child’s safety. In the event of an emergency or accident, HCAA will provide first aid, call professional emergency medical services if needed, and notify the parent/guardian or emergency contact.

2. Waiver and Release of Liability

I, on behalf of myself and my minor child, hereby waive, release, and discharge any and all claims for liability, damages, or causes of action against HCAA, including its directors, officers, employees, agents, and instructors, that may arise from or be in connection with participation in HCAA activities. This release applies to any injury, loss, or damage sustained, whether caused by negligence or otherwise, to the fullest extent permitted by law.

3. Media Release I grant HCAA permission to use my and/or my minor child’s name, likeness, image, voice, and related materials for promotional purposes in any media, worldwide, and in perpetuity, without further consent or compensation. All rights, including copyright, shall belong to HCAA, its successors, and assigns.

4. Acknowledgment and Agreement I represent that I am the parent or legal guardian of the minor named in this agreement and have the legal authority to grant the rights and releases stated above. I acknowledge that I have read and fully understand the terms of this waiver and release, and I agree to be bound by them on my own behalf and on behalf of my minor child.

Parent/Guardian Signature

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Student Applicant Signature

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Date of application

Month

Day

Year

An annual membership fee is required to participate in the Youth Membership Council and helps support program activities and resources.

$65